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Mental Health Crisis: The Second Wave of COVID-19

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COVID-19 has stopped the world in its tracks. The government-issued stay-at-home orders go against our innate, natural inclination to be social creatures. We have to be less “human”—avoiding physical touch, social gatherings, or simply helping a stranger with their groceries—all for the sake of protecting humanity.

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Social distancing, quarantining, and many more factors—such as job loss, financial struggles, and increasing household roles—put our mental health at risk.

Social distancing, quarantining, and many more factors—such as job loss, financial struggles, and increasing household roles—put our mental health at risk. Going beyond the effects of the virus itself, these factors may lead to a mental health crisis.

To discuss this concept in detail, we talked to Dr. Fred Lewis, a psychiatrist and PRA’s Vice President of Medical and Scientific Affairs.

“We are highly socialized. We cluster ourselves,” says Lewis, when explaining that humans are a social species. “When it comes to social distancing during COVID-19, it can be especially challenging in crowded places. New York is probably the best example of where we've built a tremendous population density to the point that now it's almost impossible for them to control the transmission of the contagion. Even the concept of social distancing is virtually impossible in New York. I've never been in New York City and kept myself six feet away from anyone.”

We’re all inside our homes now, whether we’re caring for ourselves or our families, working from home, or doing all three.

“This is taking us to a place that we're not used to,” says Lewis. “When we think about our lives now, especially those of us who are working from home, we don't have the social interaction that we have in an office setting.”

When Lewis talks about social interaction, he doesn’t necessarily mean having long conversations and group hangouts after work. He brings up the importance of those precious day-to-day interactions we have with coworkers, friends, and neighbors, that all add up to our social exposure.

“We don't have ‘the water cooler’ right now, where everyone will gather around and share some stories about what they did on the weekend and how their kids are doing at school. Those little moments are important to us. They keep us connected,” Lewis says. “We all want to belong to things. We all want to be part of something.”

Whether or not you have the ability to work from home, it’s difficult to feel like the world is the same as it was before COVID-19.

“This is the first wave, which is the infectious disease wave,” says Lewis. “Then there's going to be what everyone's describing in the mental health community as a second wave, and the second wave is not going to be an infectious disease wave. It's going be a mental health wave. As we get through this crisis, there will be a tremendous fallout on the mental health side.”

As we get through this crisis, there will be a tremendous fallout on the mental health side.

This uncertainty can trigger anxiety and depression in those who don’t normally experience symptoms, but it also exacerbates symptoms for those already diagnosed with disorders—for example, those who experience obsessive compulsive disorder (OCD).

“If you have a patient with OCD we look for ‘the big three’ obsessive compulsive behaviors—washing, checking, and counting,” Lewis says.

These three behaviors are exacerbated during the time of a pandemic. For example, patients could constantly be washing themselves even more frequently than in the absence of a viral pandemic, they are obsessed with fear of getting infected. They might be constantly checking their cleanliness and counting the amount of times they clean a surface.

“These patients are going to suffer worse during this time, because now, their fears of spreading infection are real and not just imagined.” Lewis added.

Similarly a patient with a psychotic, mood or anxiety disorder may experience an exacerbation of symptoms as well. Stress is no friend to these patients, and a global pandemic will stress the healthiest among us, for many of these patients the cumulative stress of their illness along with the enforced isolation and fear will lead to an increase in psychiatric visits and hospitalizations.

“Many of these patients are breaking down and struggling, and the same goes for people with addiction,” says Lewis. A recent report from the hospitals in the city of Los Angeles notes a marked increase in the number of alcohol related ER visits and hospitalization since the COVID-19 shutdown.

Some people who don’t have a history of mental health issues may start to face psychological struggles they’ve never encountered before.

“In my conversations with practicing colleagues in mental health community, they are seeing an explosion in stress-related disorders in the people who were not previously mental health consumers,” says Lewis. “Some are reaching out as they are experiencing a great deal of stress, along with symptoms such as anxiety, insomnia, irritability, and anger. There's been an increase in alcohol use, and people requesting anxiolytic medications.”

Thankfully, patients are still able to visit their psychiatrists and psychologists through telehealth technology. With so many people struggling, there seems to be a large demand for these services, which is taking its toll on mental healthcare. According to Lewis, therapists are working and/or volunteering an extra ten or fifteen hours a week, getting too overwhelmed to see all the patients who are looking for help.

“You want to hold people and hug them, but you can't do that,” says Lewis. “These things over time are really going to take a toll on how resilient we can be. Some people will come through this and be okay. Others are going to be, in many ways, emotionally damaged, and need longer term professional treatment.”

One positive emerging from this crisis is the increased focus on the mental health community. People are coming together to address mental health during these uneasy times.

State governors like Andrew Cuomo of New York have begun to address this need, stating that health systems don't just need anesthesiologists and pulmonologists, and infectious disease experts and emergency room physicians. They are in need of psychiatrists, psychologists along with other mental health professionals.

“Hopefully what does come out of it is a better policy,” says Lewis.

When asked about what we can do now to help our total health, and what to focus on for the future, Lewis suggests that the most important advice that we can provide our colleagues is to try to keep their lives as routine as they've been in the past: “The good news is, the vast majority of people who’re suffering are seeking our help.”

Additionally, people are taking measures to share their feelings and struggles through social media. Lewis says he’s seeing people who are trying to be very uplifting and supportive on various social media platforms, reaching out to people and wanting to do more within the community.

Despite these positive messages and acts of kindness, Lewis warns that the longer people are in quarantine and forced to stay apart, the longer the aftershock effects this pandemic will have on our world’s mental health. As humanity begins to bring COVID-19 under control with vaccines and treatments, the mental health issues and concerns stemming from COVID-19 will continue on. As more and more people enter the mental health system, there will need to be more services and easier access to mental healthcare.